Higher out-of-pocket costs for patients with MBS freeze: AMA

16 October, 2013

The AMA has finalised the AMA List of Medical Services and Fees 2013, which provides guidance to AMA members in setting their fees based on their own practice cost experience.

Dr Steve Hambleton, AMA president, said recently that Medicare Benefits Schedule (MBS) patient rebates continue to lag behind the real cost of providing quality patient care, but this year patient out-of-pocket costs will be higher because of the freeze on MBS indexation.

The previous government announced a delay in MBS indexation from 1 November 2013 to 1 July 2014 in the May Budget — a decision that has denied patients $664.3 million in rebates for their GP visits and private surgery.

As a result of the freeze, the MBS patient rebate for a standard Level B GP consultation will remain at the current level of $36.30 until 1 July next year.

The new AMA fee for a standard Level B GP consultation is $73, up from $71 in 2012.

Dr Hambleton said there is a long history of MBS indexation lagging well behind the contemporary costs of providing medical care, which has caused a significant difference between the AMA fees and MBS fees today.

"The MBS simply has not kept pace with the complexity or cost of providing high quality medical services," Dr Hambleton said.

"The difference between patients' medical fees and Medicare rebates will be greater because of the freeze but, despite the widening gap, doctors have kept medical fee increases to a minimum.

"Eighty one per cent of GP consultations are bulk billed.

"Eighty nine per cent of privately insured in-hospital medical services are charged according to the patient's private health insurer's schedule of medical benefits, which means the patient has no out-of-pocket cost for their doctor's fee.

"The average total out-of-pocket costs per person for medical fees in 2011-12 was $131, only $2 more than the previous year.

"The AMA applauds the private health insurers that have stuck with the tradition of indexing their schedule of benefits on 1 November.

"These insurers have acted in good faith to minimise the cost impact on their members."

This year, AMA fees have been indexed, on average, by 2.93 per cent. This compares with the Labour Price Index of 3.19 per cent and Consumer Price Index of 2.40 per cent.

The AMA indexation places significant weight on increases in the Labour Price Index because of the high labour component in providing medical services.

Practice costs — such as wages for practice staff, rent, electricity, computers, continuing professional development, accreditation, and professional insurance — must all be met from the single fee charged by the doctor.